Publications by authors named "Tanyaporn Nakornchai"

12 Publications

  • Page 1 of 1

Number of attempts required by emergency physicians to achieve competency in diaphragmatic ultrasound imaging.

J Clin Ultrasound 2022 Feb 31;50(2):256-262. Epub 2021 Dec 31.

Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Purpose: This research aimed to determine the number of attempts that emergency physicians need to become proficient in undertaking diaphragmatic ultrasound imaging.

Methods: A prospective observational study was conducted at the emergency department (ED) of a tertiary-care university hospital. Sixteen emergency physicians were each required to obtain a set of images of the right hemidiaphragm of five dyspneic patients using both diaphragmatic excursion and thickness techniques. The images were subsequently reviewed by a specialist using American College of Emergency Physician guidelines. If the evaluations of a physician did not reach the expected standard, the physician was to be given feedback and requested to collect images from another five patients. The process was to be repeated until such time as the images obtained by the physician were deemed to be up to standard.

Results: Eighty patients, twelve emergency medicine residents, and four attending physicians were enrolled. Following a didactic session on diaphragmatic ultrasound imaging and its interpretation, practicing on five patients proved sufficient to achieve an adequate level of competency in conducting diaphragmatic ultrasound examinations.

Conclusion: Practicing on five patients is sufficient for emergency physicians to achieve an adequate level of competency in conducting right-sided diaphragmatic ultrasound examinations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jcu.23133DOI Listing
February 2022

Impact of the motorcycle-taxi cardiopulmonary resuscitation (CPR) project on bystander CPR in the Bangkoknoi district of Bangkok, Thailand.

Resuscitation 2021 05 2;162:180-181. Epub 2021 Mar 2.

Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.resuscitation.2021.02.037DOI Listing
May 2021

The utility of the 1-hour high-sensitivity cardiac troponin T algorithm compared with and combined with five early rule-out scores in high-acuity chest pain emergency patients.

Int J Cardiol 2021 01 1;322:23-28. Epub 2020 Sep 1.

Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok, Bangkoknoi 10700, Thailand.

Background: Although the 0/1 h high-sensitivity cardiac troponin T (0/1 hs-cTnT) algorithm and many risk scores have been validated for use in emergency departments (EDs), their utility in high-acuity ED patients has not been validated. We aimed to validate the 0/1 hs-cTnT algorithm and the HEART, TIMI, GRACE, T-MACS and NOTR risk scores before and after combining the 0/1 algorithm in high-acuity ED chest pain patients.

Methods: A prospective observational study was conducted in the high-acuity ED of Siriraj Hospital, a tertiary hospital in Bangkok, Thailand. Adult patients with chest pain were enrolled between November 2018 and November 2019. The primary outcome was 30-day major adverse cardiac events (30-day MACE), defined as a composite of mortality, acute myocardial infarction, significant coronary stenosis and revascularization procedures.

Results: Of 350 recruited patients, 59 (16.9%) developed 30-day MACE. For the 0/1 hs-cTnT algorithm, sensitivity and negative predictive value (NPV) were 91.3% (95%CI 79.2-97.6%) and 97.2% (95%CI 93.2-98.9%), respectively. Specificity and positive predictive value were 79.6% (95%CI 72.8-85.2%) and 53.9% (95%CI 46.2-61.3%), respectively. Of the risk scores, the HEART score had the highest area under the receiver operator characteristic curve (0.74 [95%CI 0.68-0.81]). Combining the 0/1 hs-cTnT algorithm, a TIMI score cut-off of ≤1 had the best sensitivity and NPV (both 100%) and identified the greatest proportion of patients (24.3%) suitable for safe discharge.

Conclusion: The 0/1 hs-cTnT algorithm may be feasible in Asian high-acuity ED patients. The HEART score outperformed other scores in predicting 30-day MACE. Combining the 0/1 hs-cTnT algorithm with a TIMI cut-off score ≤ 1 had the best rule-out performance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2020.08.099DOI Listing
January 2021

Role of Point-of-Care Testing in Reducing Time to Treatment Decision-Making in Urgency Patients: A Randomized Controlled Trial.

West J Emerg Med 2020 Feb 25;21(2):404-410. Epub 2020 Feb 25.

Siriraj Hospital, Mahidol University, Department of Emergency Medicine, Bangkok, Thailand.

Introduction: Shortening emergency department (ED) visit time can reduce ED crowding, morbidity and mortality, and improve patient satisfaction. Point-of-care testing (POCT) has the potential to decrease laboratory turnaround time, possibly leading to shorter time to decision-making and ED length of stay (LOS). We aimed to determine whether the implementation of POCT could reduce time to decision-making and ED LOS.

Methods: We conducted a randomized control trial at the Urgency Room of Siriraj Hospital in Bangkok, Thailand. Patients triaged as level 3 or 4 were randomized to either the POCT or central laboratory testing (CLT) group. Primary outcomes were time to decision-making and ED LOS, which we compared using Mann-Whitney-Wilcoxon test.

Results: We enrolled a total of 248 patients: 124 in the POCT and 124 in the CLT group. The median time from arrival to decision was significantly shorter in the POCT group (106.5 minutes (interquartile [IQR] 78.3-140) vs 204.5 minutes (IQR 165-244), p <0.001). The median ED LOS of the POCT group was also shorter (240 minutes (IQR 161.3-410) vs 395.5 minutes (IQR 278.5-641.3), p <0.001).

Conclusion: Using a point-of-care testing system could decrease time to decision-making and ED LOS, which could in turn reduce ED crowding.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5811/westjem.2019.10.43655DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081845PMC
February 2020

High-Flow Nasal Cannula Versus Conventional Oxygen Therapy in Relieving Dyspnea in Emergency Palliative Patients With Do-Not-Intubate Status: A Randomized Crossover Study.

Ann Emerg Med 2020 05 19;75(5):615-626. Epub 2019 Dec 19.

Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Study Objective: Palliative patients often visit the emergency department (ED) with respiratory distress during their end-of-life period. The goal of management is alleviating dyspnea and providing comfort. High-flow nasal cannula may be an alternative oxygen-delivering method for palliative patients with do-not-intubate status. We therefore aim to compare the efficacy of high-flow nasal cannula with conventional oxygen therapy in improving dyspnea of palliative patients with do-not-intubate status who have hypoxemic respiratory failure in the ED.

Methods: This randomized, nonblinded, crossover study was conducted with 48 palliative patients aged 18 years or older with do-not-intubate status who presented with hypoxemic respiratory failure to the ED of Siriraj Hospital, Bangkok, Thailand. The participants were randomly allocated to conventional oxygen therapy for 60 minutes, followed by high-flow nasal cannula for 60 minutes (n=24) or vice versa (n=24). The primary outcome was modified Borg scale score. The secondary outcomes were numeric rating scale score of dyspnea and vital signs.

Results: Intention-to-treat analysis included 44 patients, 22 in each group. Baseline mean modified Borg scale score was 7.6 (SD 2.2) (conventional oxygen therapy first) and 8.2 (SD 1.8) (high-flow nasal cannula first). At 60 minutes, mean modified Borg scale score in patients receiving conventional oxygen therapy and high-flow nasal cannula was 4.9 (standard of mean 0.3) and 2.9 (standard of mean 0.3), respectively (mean difference 2.0; 95% confidence interval 1.4 to 2.6). Results for the numeric rating scale score of dyspnea were similar to those for the modified Borg scale score. Respiratory rates were lower with high-flow nasal cannula (mean difference 5.9; 95% confidence interval 3.5 to 8.3), and high-flow nasal cannula was associated with a significantly lower first-hour morphine dose.

Conclusion: High-flow nasal cannula was superior to conventional oxygen therapy in reducing the severity of dyspnea in the first hour of treatment in patients with do-not-intubate status and hypoxemic respiratory failure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2019.09.009DOI Listing
May 2020

A Woman With Leg Pain.

Ann Emerg Med 2019 12;74(6):e115-e116

Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2019.06.031DOI Listing
December 2019

Physician professionalism: definition from a generation perspective.

Int J Med Educ 2018 Sep 28;9:246-252. Epub 2018 Sep 28.

Department of Emergency Medicine, University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand.

Objectives: The primary objective of this study was to determine whether consensuses on the definition of emergency physician professionalism exist within and among four different generations. Our secondary objective was to describe the most important characteristic related to emergency physician professionalism that each generation values.

Methods: We performed a cross-sectional survey study, using a card-sorting technique, at the emergency departments of two university-based medical centers in the United States. The study was conducted with 288 participants from February to November 2017. Participants included adult emergency department patients, emergency medicine supervising physicians, emergency medicine residents, emergency department nurses, and fourth- and second-year medical students who independently ranked 39 cards that represent qualities related to emergency physician professionalism. We used descriptive statistics, quantitative cultural consensuses and Spearman's correlation coefficients to analyze the data.

Results: We found cultural consensuses on emergency physician professionalism in Millennials and Generation X overall, with respect for patients named the most important quality (eigenratio 5.94, negative competency 0%; eigenratio 3.87, negative competency 1.64%, respectively). There were consensuses on emergency physician professionalism in healthcare providers throughout all generations, but no consensuses were found across generations in the patient groups.

Conclusions: While younger generations and healthcare providers had consensuses on emergency physician professionalism, we found that patients had no consensuses on this matter. Medical professionalism curricula should be designed with an understanding of each generation's values concerning professionalism. Future studies using qualitative methods across specialties, to assess definitions of medical professionalism in each generation, should be pursued.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5116/ijme.5ba0.a584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387766PMC
September 2018

Tricuspid annular plane of systolic excursion to prognosticate acute pulmonary symptomatic embolism (TAPSEPAPSE study).

J Ultrasound Med 2019 Mar 4;38(3):695-702. Epub 2018 Sep 4.

Department of Emergency Medicine, University of California, Irvine, Orange, California, USA.

Introduction: The imaging standard for evaluation of acute pulmonary embolism (PE) includes a computed tomography pulmonary angiogram. Ultrasonography has shown promise in obtaining the tricuspid annular plane systolic excursion (TAPSE) measurements, which may be of clinical importance in patients with acute PE. The objective of this study is to evaluate the diagnostic capability of TAPSE measurements for patients with suspicion for acute PE.

Methods: We prospectively enrolled patients who came to the emergency department with suspicion of acute PE. Each patient underwent a point-of-care sonogram where a TAPSE measurement was obtained, followed by computed tomography pulmonary angiogram. Based on the computed tomography pulmonary angiogram findings, patients were grouped into 3 categories: no acute PE, clinically insignificant acute PE, or clinically significant acute PE.

Results: We enrolled 87 patients in this study. Twenty-three (26.4%) of these patients were diagnosed with PE. Of patients with PE, 15 (65%) were found to have a clinically significant acute PE. Analysis of mean TAPSE measurements between patients with clinically significant acute PE and those with insignificant or no PE was 15.2 mm and 22.7 mm, respectively (P ≤ .0001). Following receiver operating characteristic curve analysis, optimum TAPSE measurement to identify clinically significant acute PE is 18.2 mm. A cutoff TAPSE measurement of 15.2 mm shows a sensitivity of 53.3% (95% confidence interval, 26.7%-80%) and a specificity of 100% (95% confidence interval, 100%-100%) for the diagnosis of a clinically significant PE.

Conclusions: Our data suggest that TAPSE measurements less than 15.2 mm have a high specificity for identifying clinically significant acute PE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jum.14753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628892PMC
March 2019

Outcomes of Emergency Medical Service Usage in Severe Road Traffic Injury during Thai Holidays.

West J Emerg Med 2018 Mar 20;19(2):266-275. Epub 2018 Feb 20.

Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Emergency Medicine, Bangkok, Thailand.

Introduction: Thailand has the highest mortality from road traffic injury (RTI) in the world. There are usually higher incident rates of RTI in Thailand over long holidays such as New Year and Songkran. To our knowledge, there have been no studies that describe the impact of emergency medical service (EMS) utilization by RTI patients in Thailand. We sought to determine the outcomes of EMS utilization in severe RTIs during the holidays.

Methods: We conducted a retrospective review study by using a nationwide registry that collected RTI data from all hospitals in Thailand during the New Year holidays in 2008-2015 and Songkran holidays in 2008-2014. A severe RTI patient was defined as one who was admitted, transferred to another hospital, or who died at the emergency department (ED) or during referral. We excluded patients who died at the scene, those who were not transported to the ED, and those who were discharged from the ED. Outcomes associated with EMS utilization were identified by using multiple logistic regression and adjusted by using factors related to injury severity.

Results: Overall we included 100,905 patients in the final analysis; 39,761 severe RTI patients (39.40%; 95% confidence interval [CI] 95% CI [39.10%-39.71%]) used EMS transportation to hospitals. Severe RTI patients transported by EMS had a significantly higher mortality rate in the ED and during referral than that those who were not (2.00% vs. 0.78%, < 0.001). Moreover, EMS use was significantly associated with increased mortality rate in the first 24 hours of admission to hospitals (1.38% for EMS use vs. 0.57% for no EMS use, < 0.001). EMS utilization was a significant predictor of mortality in EDs and during referral (adjusted odds ratio [OR] 2.19; 95% CI [1.88-2.55]), and mortality in the first 24 hours of admission (adjusted OR 2.31; 95% CI [1.95-2.73]).

Conclusion: In this cohort, severe RTI patients transported by EMS had a significantly higher mortality rate than those who went to hospitals using private vehicles during these holidays.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5811/westjem.2017.11.35169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851498PMC
March 2018

High-Flow Nasal Cannula Versus Conventional Oxygen Therapy in Emergency Department Patients With Cardiogenic Pulmonary Edema: A Randomized Controlled Trial.

Ann Emerg Med 2017 Oct 23;70(4):465-472.e2. Epub 2017 Jun 23.

Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address:

Study Objective: High-flow nasal cannula is a new method for delivering high-flow supplemental oxygen for victims of respiratory failure. This randomized controlled trial compares high-flow nasal cannula with conventional oxygen therapy in emergency department (ED) patients with cardiogenic pulmonary edema.

Methods: We conducted an open-label randomized controlled trial in the ED of Siriraj Hospital, Bangkok, Thailand. Patients aged 18 years or older with cardiogenic pulmonary edema were randomly assigned to receive either conventional oxygen therapy or high-flow nasal cannula. The primary outcome was the respiratory rate 60 minutes postintervention.

Results: We enrolled 128 participants (65 in the conventional oxygen therapy and 63 in the high-flow nasal cannula groups). Baseline high-flow nasal cannula and conventional oxygen therapy mean respiratory rates were 28.7 breaths/min (SD 3.2) and 28.6 breaths/min (SD 3.5). Mean respiratory rates at 60 minutes postintervention were lower in the high-flow nasal cannula group (21.8 versus 25.1 breaths/min; difference 3.3; 95% confidence interval 1.9 to 4.6). No significant differences were found in the admission rate, ED and hospital lengths of stay, noninvasive ventilation, intubation, or mortality.

Conclusion: In patients with cardiogenic pulmonary edema in the ED, high-flow nasal cannula therapy may decrease the severity of dyspnea during the first hour of treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2017.03.028DOI Listing
October 2017

Prevalence of emergency medical service utilisation in patients with out-of-hospital cardiac arrest in Thailand.

Emerg Med J 2016 Mar 3;33(3):213-7. Epub 2015 Nov 3.

Department of Emergency Medicine, Siriraj Hospital, Bangkok, Thailand.

Background: Most patients with out-of-hospital cardiac arrest (OHCA) have grave outcomes. The efficacy of emergency medical services (EMS) may affect outcomes. However, no data exists in Thailand.

Objectives: To ascertain the prevalence of EMS utilisation in patients with OHCA transferred to Siriraj Hospital and also to elucidate the rates of return of spontaneous circulation (ROSC), hospital admission and survival to hospital discharge.

Methods: This prospective cohort study was conducted in patients with OHCA at a university hospital in Bangkok, Thailand from May 2011 to February 2013. The data was gathered by interviewing bystanders. Data about the mode of transportation, reasons for EMS usage, response time, ROSC and 30-day mortality were collected. Patients with rigour mortis or livor mortis were excluded. The factors affecting ROSC and survival rate were determined by univariate analysis.

Results: One hundred and fifty-two patients were included. The prevalence of EMS usage was 14.5% (95% CI 9.3 to 21.0). The most common cause of non-usage of EMS was not knowing or forgetting an EMS number (49.2%). The proportion of bystanders having known an EMS number and using EMS was 34%. The ROSC and 30-day survival rates were 53.3% and 10.5%, respectively. Non-cardiac causes and witnessed arrests were associated with ROSC (p<0.05).

Conclusions: The prevalence of EMS utilisation in OHCA at Siriraj Hospital was very low. This may affect the outcomes of patients with OHCA. Improving the EMS system by publicity to increase public awareness and providing life-support education nationwide may improve outcomes of patients with OHCA in Thailand.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/emermed-2015-204818DOI Listing
March 2016

Sepsis resuscitation guideline implementation in the Department of Emergency Medicine, Siriraj Hospital.

J Med Assoc Thai 2014 Oct;97(10):1047-54

Background: Sepsis management guidelines have been implemented in the Emergency Department, Siriraj Hospital since 2005.

Objective: Assess the impact ofsepsis resuscitation guidelines on the mortality ofpatients after implementation.

Material And Method: A prospective cohort study was conducted in the Emergency Department, Siriraj Hospital between January 12 and October 2, 2011. Patients aged older than 18 years old were included The baseline data and the extent of goal achievement were recorded The primary outcome was the 30-day mortality rate.

Results: One hundredfortyfour patients (34% severe sepsis, 66% septic shock) were included The overall 30-day mortality was 39.6%. Antibiotics were administered within I hour in 52.2% of the patients. At least I or at least 2 therapeutic goals were accomplished in 86.8% and 50.7% of patients, respectively, and the achievement of at least 2 goals was associated with lower mortality (adjusted OR 0.41, 95% CI 0.19-0.89). Two patients (1.4%) completely achieved goals within 6 hours. Respiratory failure requiring endotracheal tube insertion was associated with higher mortality (adjusted OR 3.12, 95% CI 1.32-7.38).

Conclusion: The 30-day mortality was 39.6%. The achievement of at least 2 goals was associated with lower mortality. Endotracheal tube insertion was associated with higher mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2014
-->